The topic of healthcare disparities isn’t new news. Medicine has long struggled to ensure equal care and access for all and to all. Advances have brought the field further, reaching locations and people groups in unseen ways. However, barriers still exist, and efforts to remove them are still underway.
One obstacle standing between provider and patient is limited knowledge. This creates a lack of awareness and understanding of all patients’ needs, particularly among populations defined as unique or unfamiliar to many medical professionals. This notion is particularly true as it relates to the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community. A review of anti-LGBTQ+ discrimination in U.S. healthcare conducted by the Human Rights Watch organization notes that patients among this group reported numerous incidents of prejudice. Areas of intolerance include fertility treatment, counseling, and routine screening denials. The Center of American Progress published a study in 2020 revealing that 15% of 1,528 self-identified LGBTQ+ respondents opted to defer or avoid medical care worried about facing discrimination. One in three transgender participants reported having to educate healthcare professionals about their sexual identity to receive adequate care.
Studies like these reveal a critical mission is required to teach medical providers about the healthcare needs of this unique community. The research article “The Message Is You Don’t Exist”: Exploring Lived Experiences of Rural Lesbian, Gay, Bisexual, Transgender, Queer/Questioning (LGBTQ) People Utilizing Health care Services, by Nadine R. Henriquez, RN, MN and Nora Ahmad, DMedSci notes, LGBTQ+ patients suffer from insufficient care, not because of hate but ultimately due to a fundamental lack of provider awareness, which could lead to adverse effects. Misdiagnosis is one thing, but never having the opportunity to diagnose is another. Since a great deal of LGBTQ+ persons avoid receiving care altogether, this decision means treatment and remedy for conditions may go unoffered, leading to poorer health and outcomes that are harmful yet avoidable.
This education barrier also amounts to missed diagnoses. Although many of the health needs of the LGBTQ+ community are similar to other patients, there are some unique care concerns providers should be aware of and well-versed to care for. Brittany Bass and Hassan Nagy’s article, Cultural Competence in the Care of LGBTQ Patients, highlights higher rates of depression, eating disorders, sexually transmitted infections and HIV transmission, and substance abuse as challenges patients within this community can distinctly grapple with. Additionally, undisclosed healthcare decisions such as sexual practices, hormone utilization, and alternative medicines directly affect the patient’s wellness. Without a solid care understanding, presumptions about the patient’s health are made, and plans for healthy living are established that may or may not address the patient’s most prominent well-being issues.
How can medical professionals begin to change this current plight?
The starting line is in helping all patients feel welcomed and well cared for. Paula M. Neira, Program Director of LGBTQ++ Equity and Education, Johns Hopkins Medicine Office of Diversity, Inclusion, and Health Equity, encourages creating an environment that allows patients to be open and honest. Physicians should create a safe space for their LGBTQ+ patients. It should be made clear that sharing their medical history is crucial, particularly for first-time visits. Consider including questions on medical forms that address sexual orientation and identity. Including these questions will begin to create an open-door policy between provider and patient. Be sure to include a check box for the patient to request a more-depth discussion pertaining to this topic.
Create space and make time to follow up on this request. As the patient’s provider, initiating the conversation indirectly conveys a message of interest and a willingness to learn. The objective is to ensure patients don’t feel judged or misunderstood by those who should be on their side. The clinician and patient relationship is built on trust. The willingness and art of adjusting one’s bedside manner will make all the difference when partnering with patients, especially LGBTQ+ patients.
As with anything within medicine, training takes the professionals in the field even further. Increasing provider education on how to tend to the medical needs of this community, along with understanding the psychosocial challenges they face, will aid in eliminating the barriers that exist today. Adjusting curriculums to introduce training to medical students is another initiative in progress to assist in physician growth, providing the knowledge they need to deliver appropriate care. For example, the Johns Hopkins University School of Medicine has updated its medical curriculum to empower and ready its students to connect with and tend to the diverse patient populations they’ll serve.
Ultimately, increased training in LGBTQ+ healthcare must be enactment to reduce and stop discrimination in the healthcare setting for these patients. The Human Rights Campaign and the Nurse Journal provide a few resources to assist in developing the awareness required to care for this community well. Remember, when the medical field couples education with immutable empathy, equitable healthcare can become a reality for all!